title: Cataract surgical coverage and self-reported barriers to cataract surgery in a rural Myanmar population.
abstract: OBJECTIVE
  The aim of this study is to determine the cataract surgical coverage and investigate the barriers to cataract surgery as reported by those with cataract-induced visual impairment in rural Myanmar.
  
  
  METHODS
  A cross-sectional, population-based survey of inhabitants 40 years of age and over from villages in the Meiktila District (central Myanmar); 2481 eligible participants were identified and 2076 participated. Data recording included corrected visual acuity, dilated slit lamp examination and stereoscopic fundus examination. Lens opacity was graded using the Lens Opacities Classification System III. Participants with cataract-induced visual impairment (acuity < 6/18 in better eye) were also invited to respond to a verbal questionnaire about barriers to cataract surgery.
  
  
  RESULTS
  Cataract surgical coverage for visual acuity cut-offs of <6/18, <6/60 and <3/60 was 9.74%, 20.11% and 22.3%, respectively, for people and 4.18%, 9.39% and 13.47%, respectively, for eyes. Cataract surgical coverage was higher for men than women, but gender was not associated with refusal of services. Of the 239 who responded to the extra questionnaire, 216 were blind or had low vision owing to cataract. Three quarters refused referral for surgery: cost and fear of surgery were the most frequently reported barriers.
  
  
  CONCLUSIONS
  Cost plays a large role in the burden of cataract in this region. Implementation of educational programmes, reforms to local health service and subsidization of ophthalmic care may improve the uptake of cataract surgery.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia. athanasiov@yahoo.com
authors.forename: Paul A
authors.initials: PA
authors.lastname: Athanasiov
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Casson
authors.forename: Henry S
authors.initials: HS
authors.lastname: Newland
authors.forename: Win K
authors.initials: WK
authors.lastname: Shein
authors.forename: James S
authors.initials: JS
authors.lastname: Muecke
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
authors.forename: Than
authors.initials: T
authors.lastname: Aung
mesh_terms: D000368:Aged; D001766:Blindness / Q000209:etiology; D002386:Cataract / Q000150:complications / Q000453:epidemiology; D002387:Cataract Extraction / Q000191:economics* / Q000523:psychology / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004608:Eligibility Determination / Q000706:statistics & numerical data*; D005190:Family; D005239:Fear; D005260:Female; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D002052:Myanmar / Q000453:epidemiology; D012424:Rural Population / Q000706:statistics & numerical data*; D012944:Social Support; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000523:psychology / Q000706:statistics & numerical data; D015354:Vision, Low / Q000209:etiology